System and method for assembling a folded percutaneous valve

ABSTRACT

The invention provides a multi-component (modular) percutaneous valve device that includes a valve module having valve leaflets and a valve frame. The valve frame includes one or more, for example two, ring members and a plurality of masts. Also provided is a valve frame having specially designed pivot points at the connection between masts and first and second ring members to assist folding the valve module and minimizing delivery diameter. The valve frame may also include wire guides to facilitate combining the valve module with a support module. The masts or a ring of the valve frame may also include locking members, such as shafts for closing the valve module and securing the valve module to the support module. The support module includes corresponding locking members, such as spears that align with the shafts on the valve module for assembly and locking the valve module to the support module.

This application claims benefit of priority to U.S. provisionalapplication Ser. No. 61/688,470, filed May 15, 2012, which isincorporated herein by reference in its entirety.

FIELD OF INVENTION

The present invention relates to a system and method for deploying andassembling a modular percutaneous valve device. In particular, themodular valve device includes novel features to facilitate folding andassembly of the valve module, and the system includes novel features fordeployment, combining and securing the device modules together.

BACKGROUND OF THE INVENTION

The human body contains a wide variety of natural valves, such as, forexample, heart valves, esophageal and stomach valves, intestinal valves,and valves within the lymphatic system. Natural valves can degeneratefor a variety of reasons, such as disease, age, and the like. Amalfunctioning valve fails to maintain the bodily fluid flow in a singledirection with minimal pressure loss. An example of a malfunctioningvalve is a heart valve that may be either stenotic, i.e., the leafletsof the valve do not open fully, or regurgitant, i.e., the leaflets ofthe valve do not close properly. It is desirable to restore valvefunction to regain the proper functioning of the organ with which thevalve is associated. For example, proper valve function in the heartensures that blood flow is maintained in a single direction through avalve with minimal pressure loss, so that blood circulation and pressurecan be maintained. Similarly, proper esophageal valve function ensuresthat acidic gastric secretions do not irritate or permanently damage theesophageal lining.

Several percutaneous prosthetic valve systems have been described. Oneexample described in Andersen, et. al. (U.S. Pat. No. 5,411,552)comprises an expandable stent and a collapsible valve which is mountedonto the stent prior to deployment. The collapsible valve may be abiological valve or it may be made of synthetic material. The Andersonprosthetic valve is delivered and deployed using a balloon catheterwhich balloon is used to expand the valve-stent prosthesis to its finalsize. See also, U.S. Pat. No. 6,168,614 (Andersen, et al.) entitled“Valve Prosthesis for Implantation in the Body” and U.S. Pat. No.5,840,081 (Andersen, et al.) entitled “System and Method for ImplantingCardiac Valves.”

Spenser, et. al. (U.S. Pat. No. 6,893,460) describe another prostheticvalve device comprising a valve structure made of biological orsynthetic material and a support stent. The Spenser prosthetic valve isa crimpable leafed-valve assembly consisting of a conduit having aninlet and an outlet, made of pliant material arranged to presentcollapsible walls at the outlet. The valve assembly is affixed to thesupport stent prior to deployment. The complete valve device is deployedat a target location within the body duct using a deploying means, suchas a balloon catheter or a similar device.

Percutaneous implantation of prosthetic valves is safer, cheaper, andprovides shorter patient recovery time than standard surgicalprocedures. However, current artificial percutaneous prosthetic valveshave the disadvantage of being extremely bulky, even when compressed fordelivery. The problem with this bulkiness is that it requires thedelivery catheter to have a rather large diameter. Large cathetersgenerally are not suitable for percutaneous procedures and requirecut-down surgical procedures and/or sophisticated and difficultpuncture-closure techniques. The bulkiness and large diameter of currentvalve devices and delivery systems combined with the anatomy throughwhich the devices must be delivered also can make delivery into thelumen problematic from the point of view of success rate, accuracy ofdeployment, and risk of complications. Specifically, deliverycomplications may arise due to the shape of the lumen, for example, thesignificant natural curve of the aortic arch and/or a tortuousiliac/femoral artery through which the catheter is introduced. Further,a catheter of such diameter tends to be less flexible than a smallerdiameter catheter, especially when loaded with a bulky, inflexibledevice. Additionally, manipulating such a loaded catheter through anarrow vessel, and in particular a curved vessel, substantially raisesthe potential for damage to that vessel wall, bleeding, and othervascular complications, which are in turn related to higher rates ofmorbidity and mortality.

Still further, the valve leaflet material makes up 80% of thepercutaneous prosthetic valve delivery diameter. Current efforts tominimize the bulk of the valve leaflet material include using thinnervalve material or tightly crimping the valve leaflets. Both of theseprocedures adversely impact the durability of the valve leaflets, thelatter does so by damaging the valve material.

Therefore, a need exists to facilitate the delivery of artificial valvesand also to increase the safety of the procedure. A valve device havinga smaller delivery diameter than pre-assembled percutaneous valvedevices and that can be delivered through a vessel without incurringfurther damage to the wall of the body lumen is highly desirable. It isalso desirable to have a low profile (small delivery diameter)percutaneous prosthetic valve device that provides the type of leafletdurability available in surgical prosthetic valve devices.

US Published Patent Application No. 2010/0185275A1, incorporated hereinby reference in its entirety, describes a modular (multi-component)percutaneous valve device that facilitates delivery of the prostheticvalve by providing the valve device as deliverable modules that may beassembled into a working configuration at or near the site ofimplantation in the blood vessel. US Published Patent Application No.2010/0185275A1 also describes various means for locking together theassembled device modules.

US Published Patent Application No. 2011/0172784A1, incorporated hereinby reference in its entirety, describes a modular (multi-component)percutaneous valve device having a self-assembly member that facilitatesassembly of the modular prosthetic valve in the blood vessel. USPublished Patent Application No. 2011/0172784A1 also describes valvemodules that may assume a shape (unassembled shape) different from theirfunctional valve shape that are particularly advantageous for deliveryin that the unassembled shape permits the valve module to be folded in amanner that minimizes the delivery diameter of the device, therebyminimizing complications and increasing the safety of the valvereplacement procedure.

SUMMARY OF THE INVENTION

The present invention provides an improved modular percutaneous valvedevice and system, having components that simplify the assembly of thedevice modules. In particular, a system and method for deploying andassembling a percutaneous modular valve device is provided. Themulti-component, or modular, percutaneous valve device and systemcomprises a plurality of device modules for delivery. In one embodiment,the plurality of device modules includes a valve module and a supportmodule, which are designed to be combined into the assembled valvedevice in the body. From a functional perspective, the valve module isthe portion of the valve device having the leaflets and once assembledit provides a conduit having an inlet end and an outlet end. The supportmodule provides the anchor, or backbone, of the device, housing thevalve module and holding the valve module in place within the bodylumen. In percutaneous valve replacement procedures the native valveleaflets often are not removed prior to implantation of the prostheticvalve; thus the support module also serves to outwardly displace thenative valve leaflets to create a larger valve orifice, in particularwhen the prosthetic valve is used to treat aortic stenosis.

The valve module of the invention is provided with a valve frame havingone or more ring members, and a plurality of masts connected thereto.The one or more ring members are discontinuous, each having a first endand a second end, thereby permitting the ring members to be opened forfolding. This provides a valve module having an unassembled, foldeddelivery configuration, in which the one or more open ring members andthe masts are substantially collinear, and the valve leaflets foldedtherewith. The terms collinear and substantially collinear are usedinterchangeably herein, and are meant to convey extending in the samegeneral direction and/or linearly adjacent. Thus, for example, in thedelivery configuration, the “folded” masts lie approximately parallel tothe one or more ring members. In one embodiment, one of the masts may bea split mast, the first half of which is located at the first end of thering member(s) and the second half is located at the second end of thering member(s).

The valve module also has a working configuration in which the ends ofthe ring member(s) are approximate (i.e., close together, next to eachother) so as to form a ring, and the masts are oriented along thelongitudinal axis of the valve, generally upright relative to the ringmember(s). The valve leaflets are attached to a ring member, for examplea ring member at the base of the valve module, and in the embodimenthaving a first and second ring member the valve leaflets may besupported by the second ring member. Alternatively, or in addition, thevalve leaflets may be supported by one or more of the plurality ofmasts.

The support module has a compressed delivery configuration and anexpanded working configuration, into which the valve module may beinserted and attached. In one embodiment, the support module has aradially compressed delivery configuration and is radially expandable tothe working configuration.

The valve module and support module may further include novel structuresthat collectively facilitate guiding the valve module to the supportmodule for combination therewith, closing the valve module to form aconduit, and locking the valve module to the support module. These novelfeatures may include shafts and spears, wire guides, and assembly wires.The spears may include eyelets for cooperative use with the wire guidesto guide the valve along assembly wires into the support module.Elements such as wire guides, eyelets and assembly wires are alsoreferred to herein as “guiding members.” The shafts and spears functionas locking members to lock the valve module to the support module. Othertypes of locking members also may be used, for example, snaps or othergeometric locking mechanisms. The relative position of the lockingmembers may differ depending on the embodiment. For example, the shaftsmay be located on a component of the valve frame and the spears may belocated on the support module. Alternatively, the spears may be locatedon the valve frame and the shafts may be located on the support module.

In one embodiment in which the valve frame includes a first and secondring member with the plurality of masts disposed therebetween, theconnections between the masts and ring members may be novel pivot pointconnections. The pivot point connections facilitate folding of the valveframe while minimizing physical strain on the connections. In anotherembodiment the valve frame comprises a first ring member at the basewith the plurality of masts connected thereto via novel pivot pointconnections.

The system of the invention includes the above-described modular valvedevice, and a delivery system that includes a catheter and assemblywires. In certain embodiments, the delivery system further comprisespushers that may be advanced over the assembly wires to slide the valvemodule over the assembly wires into the support module, and may furtherbe used to lock the locking members. In embodiments that include wireguides, each assembly wire may be threaded through wire guides tominimize tangling of the assembly wires. In embodiments in which thesupport module includes spears having eyelets, the assembly wires mayadditionally be threaded through the eyelets, to facilitatedisengagement of the wire from the valve device once implanted bypulling on one end of the wire. Alternatively, the assembly wire may bethreaded through a portion of the valve frame and/or the support module.

Also provided is a method of assembling the modular percutaneous valvedevice using the novel components of the system. The valve module isadvanced over assembly wires and the wire guides are useful fororienting and assembling the valve module, and combining the valvemodule with the expanded support module. In one embodiment, the valvemodule may include shafts (tubular or ring structures) and the supportmodule may include spears, specialized structures for connecting withthe shafts, attached at positions around the circumference of thesupport module that correspond to the positions of the shafts. Theshafts may be located, for example, on the masts and/or on a ringmember. When located on masts of the valve frame, the shafts may belocated on the outer surface or the inner surface of the masts, or somecombination thereof. In another embodiment, the shafts may be located onthe support module and the spears may be located on the valve module. Ineither embodiment, the shafts may be eased over the spears and may lockin place. Where a split mast is used, the split mast may include a pairof shafts—one on each half of the split mast—which, in combination witha spear on the support module, simultaneously close the ring members toeffect a working configuration valve module and effect locking the valvemodule to the support module.

Among the advantages of the modular percutaneous valve of the presentinvention are a valve module that easily folds for delivery, readilytransforms to a near assembled configuration upon deployment from adelivery device, and provides support for the valve leaflets. Advantagesof the system of the invention include a design that facilitatesunfolding and assembly of the valve module into the workingconfiguration, aligning the valve module with the support module forcombining the device modules, and securing the device modules to eachother. Another advantage of the present invention is that because thevalve device is modular, the properties of the modules may be optimizedindependently, because the valve module and support module servedifferent functions—the valve module modulating blood flow and thesupport module anchoring the valve in the valve annulus and pinning backthe native valve leaflets; separately deploying the modules andcombining them in situ lessens the design trade-offs that are necessarywhen the valve device is a single unit.

Other advantages that may be achieved by the present invention includereducing the bulkiness of the valve for delivery while maintainingdurability of the valve leaflets, and increasing the flexibility of thedelivery device. Also, the prosthetic valve device is minimally invasiveand the method of percutaneous delivery reduces traumatic damage andminimizes procedure complications, and allows delivery to patients withsmaller vessels, with highly diseased, tortuous or occluded vessels, andreduces the risk of vascular complications. Use of the apparatus, systemand methods of the invention thereby may increase the safety of theprocedure and expand both the number of medical facilities capable ofperforming percutaneous valve replacement procedures and the number ofpatients who can receive the treatment.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic drawing of a photograph illustrating a double ringembodiment of the valve module of the invention.

FIG. 2 schematically illustrates a valve frame in its unassembledsubstantially flat configuration, showing one embodiment of pivotpoints.

FIGS. 3A-B illustrate another embodiment of a valve frame havinghorseshoe pivot points. FIG. 3A schematically illustrates the valveframe in its unassembled substantially flat configuration; FIG. 3Bschematically depicts how a ring member and mast are connected at thehorseshoe pivot point of the valve frame embodiment of FIG. 3A.

FIGS. 4A-B are photographs illustrating the embodiment of FIG. 3A valveframe in its working configuration. FIG. 4A illustrates a top view ofthe valve frame embodiment of FIG. 3A; FIG. 4B illustrates a side viewof the valve frame embodiment of FIG. 3A.

FIG. 5 is a photograph illustrating one way an embodiment of the doublering valve module may be folded according to the invention for loadinginto a delivery catheter.

FIG. 6A is a schematic drawing of a photograph illustrating anembodiment of the double ring valve module folded according to theinvention and loaded in a delivery catheter.

FIG. 6B is a schematic drawing of a photograph illustrating anembodiment of the double ring valve module during deployment from acatheter according to the invention.

FIGS. 7A-E are photographs illustrating a method of deploying andassembling an embodiment of the modular valve device according to theinvention.

FIGS. 8A-B illustrate an embodiment of how the valve module and supportmodule may be connected. FIG. 8A is a schematic drawing of a photographdepicting how a shaft on a valve module may connect to a spear having adeltoid or “kite” spearhead on a support module; FIG. 8B illustrates thesame schematically.

FIGS. 9A-B illustrate an embodiment of novel locking members. FIG. 9A isa schematic drawing of a photograph illustrating a wire guide and firstand second shafts on a valve module, and an assembly wire threadedthrough these structures. FIG. 9B schematically illustrates how thefirst and second shafts of FIG. 9A may connect to a spear of a supportmodule.

FIGS. 10A-B illustrate an embodiment of novel locking members. FIG. 10Ais a schematic drawing of a photograph illustrating illustrates how aring shaft on a valve module may connect to a hybrid spear on a supportmodule; FIG. 10B is an inset depicting the ring shaft locked on thehybrid spear.

FIGS. 11A-C. FIG. 11A schematically illustrates the hybrid spear; FIG.11B schematically illustrates a ring shaft being introduced onto thehybrid spear; FIG. 11C schematically illustrates the ring shaft lockedon the hybrid spear.

FIGS. 12A-B schematically illustrate an embodiment of a single groovehybrid spear. FIG. 12A shows the embodiment from front view coupled witha mast via ring shafts; FIG. 12B is a cut-away of the same view toreveal the spear and ring structures.

FIGS. 13A-B schematically illustrate an embodiment of a single groovehybrid spear. FIG. 13A shows the embodiment from front view coupled witha split mast via shaft and ring shaft; FIG. 13B is a cut-away of thesame view to reveal the spear, shaft and ring shaft structures.

FIG. 14A is a schematic drawing of a photograph of an exemplary valveframe for a valve module in accordance with the invention.

FIG. 14B is a schematic drawing of a photograph of an exemplary supportmodule in accordance with the invention.

FIG. 14C is a schematic drawing of a photograph of another exemplarysupport module in accordance with the invention.

FIG. 14D is a schematic drawing of a photograph showing details of anembodiment of hybrid spear on an exemplary support module in accordancewith the invention.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides an implantable modular percutaneousprosthetic valve device, system and method for deploying and assemblingimplantable percutaneous modular valve devices, for example percutaneousmodular heart valve devices.

The percutaneous valve device of the invention comprises a plurality ofdevice modules for delivery and assembly in a body lumen, for example ablood vessel. The device modules may be delivered percutaneously to adesired location in the body, for example near the site of valveimplantation or at the site of valve implantation, where they may bedeployed from the delivery device and assembled to form a working valvedevice. The plurality of device modules may include a support module anda valve module. The support module has a compressed deliveryconfiguration and an expanded working configuration. The valve modulecomprises the valve leaflets of the valve device and a valve frame; thevalve leaflets may be attached to components of the valve frame, whichinclude one or more ring members and a plurality of masts connectedthereto.

The valve module has an unassembled open configuration, in which the oneor more ring members have a substantially linear, i.e., generallystraight, configuration and the valve leaflets lie substantially flat.One skilled in the art understands that valve leaflets have a shape,e.g., including commissures, and therefore the term “substantially flat”may include some undulations. This unassembled open configurationpermits folding, e.g., rolling, of the valve module predominantly“lengthwise” into a folded delivery configuration, and from which thevalve module may be assembled into a working configuration. In theunassembled open configuration, the valve module has a width along itslongitudinal axis, i.e., apex to base, and a length along the linearcircumferential axis, i.e., along an axis defined between the first endof the one or more ring members and the second end of the one or morering members (or in embodiments having a split mast, between the firstmast half and the second mast half). Therefore, “lengthwise” isunderstood by one having ordinary skill in the art to mean along thelength, e.g., from one split mast half to the second split mast. In itsfolded configuration, the plurality of masts may be folded toward theone or more ring members so as to be substantially collinear with thesubstantially linear ring members.

The “lengthwise” folding of the valve module facilitates a deliveryconfiguration having a minimal diameter and minimizes crimping damage tothe leaflets, thereby improving durability. In particular, folding thevalve module predominantly lengthwise distributes the bulk of theleaflet material over a greater axial distance than folding orcompressing radially, so that there is less valve material at any onepoint in the delivery catheter. As a result, less crimping force isrequired on the leaflets, compared to radial crimping of currentlymarketed devices, to achieve a small delivery diameter. The resultantadvantage is less crimping damage to the leaflet material, and thusimproved durability. Additionally, it isn't necessary to use a thinnervalve material to achieve the small delivery profile. One example ofsuch advantageous predominantly lengthwise folding comprises rolling theopen unassembled valve module spirally, for example around a guide wire.Another example is scrunching the valve material as the plurality ofmasts are folded toward the one or more ring members.

In some embodiments, specialized connections between the masts and ringmembers—pivot points—may facilitate the folding. When assembled into aworking configuration, the valve module provides a conduit having aninlet end and an outlet end. The valve frame may include, in its workingconfiguration, one or more ring members with ends approximated and aplurality of masts oriented along the longitudinal axis of the valve,thereby—with the valve leaflets—forming a conduit. The valve leafletsmay be supported by one or more of the ring member(s) and masts.

The valve frame may be manufactured from any of a variety of materials,such as, for example, a shape-memory alloy, cobalt chromium, a materialhaving superelastic properties, or a polymeric deformable plastic. Inone embodiment, the valve frame comprises a shape-memory metal or alloy,pre-conditioned to revert to a preset configuration. In one aspect ofthis embodiment, the valve frame is made from a shape-memory alloy. Thepreset configuration may be referred to as a first configuration (e.g.,a relaxed state) and the delivery configuration may be referred to as asecond configuration (e.g., an unrelaxed, or restrained state). Thevalve frame may be triggered to revert to the preset configuration by,for example, a change in temperature (heating or cooling), an electricalcurrent, or if it has superelastic properties it may be released from ageometric restriction, or it may be mechanically deformed or “triggered”by balloon expansion, which, for example, may trigger conversion of, forexample, NiTi to a different phase. The shape memory alloy allows thevalve frame to be thermo-mechanically preconditioned into a preselectedshape (pre-set configuration), so that it in one embodiment it may bedelivered in, for example, a relatively straight, but axially flexiblesecond configuration and then be triggered to revert to thethermo-mechanically preset first configuration. In another embodiment,the delivery device, or a lumen within the delivery device, may restrainthe valve frame in a delivery configuration, and the trigger may be arelease from the restraint.

As used herein, “preset configuration” or “first configuration” withrespect to valve frame is not limited to shape-memory structures. By“preset configuration” and “first configuration” is meant thepre-selected shape that the valve frame assumes or reverts to afterdeployment from the delivery device. Where the valve frame is revertedto its first configuration, for example by a temperature step, thetemperature step may be effected by changing the temperature in theenvironment around the valve frame, for example by hot fluid, coolfluid, body heat, or passing electrical current through a wire togenerate resistive heat. Any shape memory alloy may be used to make theshape memory valve frame. In specific embodiments, the shape memoryalloy used is NiTi (i.e., NiTinol), CuZnAl, CuAlNi, or a mixture thereof(see, e.g., SHAPE MEMORY MATERIALS, edited by Otsuka and Wayman,Cambridge University Press; October 1999 and SHAPE MEMORY ALLOYS, editedby Youyi and Otsuka, International Academic Publishers, June 1998).

The valve leaflet material may be manufactured from suitable materials,such as polymers, metals or biological material, such as mammalianpericardium derived from, for example, bovine, porcine or equine tissue.The selection of material, structure and method of manufacturingpreferably is made to optimize the function, the durability and thebiocompatibility of the valve. The valve leaflets may be attached to thevalve frame by means known in the art, for example by sewing, gluing,bonding, or by the method described hereinbelow.

The support module preferably is expandable, so that it may be deliveredcompressed (unexpanded), and then expanded for implantation and assemblyof the valve device. The support module may be manufactured from abiocompatible material that is sufficiently durable that the structurecan support the valve component while maintaining the device's positionin the lumen. The support module material also is compatible withdelivery of the support module in a compressed state and expansion ofthe compressed support module upon deployment in the lumen. For example,the support module may be manufactured from a variety of materialsincluding a shape-memory alloy, cobalt chromium, a material havingsuperelastic properties, or a polymeric deformable plastic. In oneembodiment of the present invention, the support module is manufacturedfrom stainless steel or a shape memory alloy, such as, for example,Nitinol. In another embodiment, it may be made of an amorphous metalalloy of suitable atomic composition, as are known in the art. Otherfurther embodiments of the support module may be manufactured fromsimilar biocompatible materials known in the art. One non-limitingexample of an appropriate support module is a mesh tube. In thisexample, the support module comprises a hollow, generally cylindrical(annular) member having a side surface comprising a mesh having aplurality of apertures or cells. The support module possesses sufficientradial strength to maintain its position at the implantation site oncethe support module is deployed, to outwardly displace native valveleaflets, and to create a larger valve orifice than that of a diseasedvalve to be replaced. The support module, may be self-expanding orballoon-expandable. Examples of support modules for use in the inventionare known in the art.

The support module may include locking members, such as those describedherein, to secure the valve module within the support module. Thesupport module may further include hooks, ribs, or other anchoringdevices to facilitate the anchoring of the assembled valve device to thenative anatomy, e.g., the valve annulus. The connection of the supportmodule to the valve annulus and/or of the valve module to the supportmodule may be designed to provide adjustment to the relative positionsof the structures.

The devices and methods of the invention are particularly adapted foruse in percutaneous aortic valve replacement, but may also find use asreplacements for other cardiac valves, such as, e.g., pulmonic, mitral,and tricuspid valves, as well as valves in the peripheral vasculature orin other bodily lumens, such as the alimentary canal, lymph ducts, thebiliary duct, and any other lumens having valves requiring replacementor needing valve implantation. Where the modular valve device isdesigned to replace an aortic valve, it may be assembled in theascending aorta, the descending aorta, the left ventricle, at theimplantation site, or part at the implantation site and part in theaorta. Although particularly adapted for use in lumens of the humanbody, the devices, systems, and methods may also find application inanimals.

The aforementioned embodiments as well as other embodiments arediscussed and explained below with reference to the accompanyingdrawings. The drawings are provided as an exemplary understanding of thepresent invention and to schematically illustrate particular embodimentsof the present invention. The skilled artisan will readily recognizeother similar examples equally within the scope of the invention. Thedrawings are not intended to limit the scope of the present invention asdefined in the appended claims.

As noted above, the modular valve device of the invention comprises avalve module and support module, which may be delivered in unassembleddelivery configurations and assembled and combined after deployment froma delivery device. The valve module comprises valve leaflets attached toa valve frame. Exemplary depictions of a partially assembled valve frameand an expanded support module are illustrated in FIGS. 14A and 14B,respectively. Details of the valve module and its connection to thesupport module are set forth in FIGS. 1-13.

FIG. 1 illustrates a non-limiting embodiment of the valve moduleinvention, in which the valve frame includes a first and second ringmember. As illustrated in FIG. 1, the valve module 10, in its assembledworking configuration, includes valve leaflets 15 and a valve frame. Thevalve frame includes a first ring member 21 at the base of the valvemodule (proximal end of the valve) and a second ring member 22 at thedistal end of the valve module (distal end of the valve) and a pluralityof masts 25, 28 a, 28 b, for example three masts, extending generallyperpendicularly therebetween connecting the first and second ringmembers 21, 22. In one embodiment, the first ring member 21 is wideralong the longitudinal axis than the second ring member 22 (see FIG.14A), making the first ring member more resistant to warping, therebymaintaining the shape of the assembled valve module.

The valve leaflets 15 may be attached to one or both ring members 21, 22and/or masts 25, 28 a, 28 b. In the embodiment depicted in FIG. 1, thevalve leaflets 15 are attached to the first ring member 21 and suspendedfrom the second ring member 22, for example at points adjacent theconnection points between the masts 25, 28 a, 28 b and the second ringmember 22. FIG. 1 also illustrates an embodiment in which the valveleaflets 15 are attached to the split mast 28 a, 28 b but not the othermasts 25. The valve leaflets 15 may be attached to the valve frame, forexample, by sewing as illustrated in FIG. 1, or by any other appropriatemethod known in the art. For example, the valve leaflets 15 may besuspended via leaflet loops 16, as illustrated in FIGS. 1, 5, 6A and 6B.Alternatively, the valve leaflets 15 may be suspended or attached, e.g.,by sewing, to a second ring member 22 or a mast 25, 28 a, 28 b, or byother means within the skill in the art. The leaflet loops 16 may bemade from the same material as the valve leaflets 15 and fastened by,for example, sewing the loop closed, sewing the loop to the second ringmember 22, or some combination thereof. Alternatively, the valveleaflets 15 may be suspended from the second ring member 22 by a loopformed of sewing thread or a second material.

In one embodiment, rather than being attached directly to the valveframe, the valve leaflet material (first material) is attached to asecond, flexible, more durable material, which in turn is affixed to thevalve frame by means known in the art, e.g., looping, sewing, gluing,bonding. One embodiment for attaching the valve leaflets to the valveframe is a sandwich attachment. Specifically, in this aspect, the secondmaterial is wrapped around a portion of the valve frame, for example aring member or a mast, with sufficient segments of second materialbeyond the wrapping to allow a segment of the first material to beinserted between the two segments of the second material to form a firstmaterial-second material-first material (three-layer) sandwich. Thesecond material may then be attached to the first material, for exampleby sewing with, e.g., sutures. The first material may be, for example,pericardium and the second material may be, for example, Dacron,although other combinations of suitably materials known in the art alsomay be used.

The sandwich attachment embodiment may alternatively comprise an opensandwich (two layer). In this embodiment, the second material is wrappedaround the valve frame and attached to itself leaving a tail, which maybe separately attached to a segment of valve leaflet by means describedabove. Similar sandwich attachment designs may be used for attaching thevalve leaflets to a mast, including use of tabs or loops to accommodateattachment points of locking members on the mast. An advantage of thesandwich attachment is improved longevity of valve integrity, asabrasion of the valve leaflet material (first material) by the surfacesof the valve frame is avoided.

In its unassembled folded configuration, the first and second ringmembers 22, 22 of FIG. 1 are not closed or substantially closedstructures, but open: each is arranged in a substantially linearconfiguration, having a first end and a second end, as shown forexample, in FIGS. 2 and 3A. In one embodiment, as illustrated in FIGS.1, 2 and 3A (see also FIG. 9A), one of the masts is a split mast 28 a,28 b, such that a first half of the split mast 28 a is located at afirst end of the unassembled valve module, connected to the first end ofthe ring member(s), and a second half of the split mast 28 b is locatedat a second end of the unassembled valve module, connected to the secondend of the ring member(s). The valve leaflets 15 may be secured to eachhalf of the split mast 28 a, 28 b, for example by sewing, by the methodsdescribed above, or by any other appropriate method known in the art.

A ring member, as illustrated in FIG. 9A for a valve frame having asplit mast, may be fitted with a wire guide 30, for example, adjacentthe proximal end of a mast, through which an assembly wire 80 may bethreaded. The proximal end is the end nearest the heart when the valveis implanted to replace an aortic valve. For example, as shown in FIG.14A, a first wire guide 30 may be located on the first ring member 21(see also FIG. 9A) near the first half of a split mast 28 a, and secondwire guide 31 may be located on the second ring member 22 near thesecond half of a split mast 28 b. Similarly, a first wire guide 30 alsomay be located on the first ring member 21 near the proximal end of amast 25 and a second wire guide 31 may be located on the second ringmember 22 near the proximal end of the mast 25. While not a requiredfeature of the valve frame, the wire guides 30, 31 are useful formaintaining proper alignment of the assembly wires 80 relative to thevalve frame when deploying the valve module from the catheter.

When delivering the valve module, it must be folded to a deliveryconfiguration having a small diameter, yet be able to readily transformto a near tubular configuration after deployment for assembly andcombination with the support module. The present invention provides animproved valve frame structure for folding the valve module.

Folding the masts towards the ring members to form a substantiallycollinear folded valve frame, may cause significant stress or strain onvalve frame material at the connection points between the masts and thefirst and second ring members. Thus in one aspect of the invention, theconnection points may be designed as pivot points 70, shown, forexample, in FIG. 2. Use of pivot points, as opposed to standardunelaborated connections, facilitates folding of the valve frame topermit the first and second rings and masts to be substantiallycollinear without causing significant material strain or stress at theconnection points. Reduction in strains on the valve frame via the novelpivot points of the invention provides a further advantage of allowing aminimum cross section when the first and second rings and masts of thevalve frame are folded so as to be substantially collinear. In oneembodiment, the masts and first and second ring members are considerablystiffer than the pivot points. There are any number of ways to optimizepivot points to reduce the material strain or stress at the connectionpoints, for example adjusting the plane, thickness, width or shape ofthe connection. Two non-limiting examples of pivot points that may beused, which employ shape, are described below, but based on thisdescription one skilled in the art would understand other shapes thatmay be used for the inventive pivot points.

In one embodiment of a valve frame 20, depicted in FIG. 2, the novelpivot points 70 a, 70 b may be contained in the masts 25, 28 a, 28 b,substantially s-shaped 71, and connect to the first and second ringmembers 21, 22 at right angles. The orientation of the s-shape of thepivot point 70 a connecting the first ring member 21 to a mast 25, 28 a,28 b may be opposite (or the inverse) of the s-shape of the pivot point70 b connecting the second ring member 22 to a mast 25, 28 a, 28 b, asshown in FIG. 2. Compare 70 a and 70 b in FIG. 2. Preferably, thes-shaped pivot points 71 connecting masts to the first ring member 21have the same orientation, and s-shaped pivot points 71 connecting maststo the second ring member 22 have the same orientation. The s-shapedpivot point illustrated in FIG. 2 may also have a narrower width thanthe masts.

In another embodiment of a valve frame 120, depicted in FIGS. 3A and 3B,the novel pivot point 170 may be more complex, including a “horseshoe”connection 75 between the mast 25, 28 a, 28 b and a first segment 121 a,122 a of a ring member 121, 122 and a diagonal connection 76 between thehorseshoe member 75 and an adjacent segment 121 b, 122 b of the ringmember 121, 122. FIG. 3A illustrates this valve frame 120 embodiment inits substantially flat unassembled configuration. FIG. 3B illustratesthe pivot point 170 in greater detail. The orientation of the horseshoe75 at the mast connection to the first ring member 121 is opposite tothe orientation of the horseshoe connection 75 at the mast connection tothe second ring member 122. Concomitantly, the orientation of thediagonal member 76 between the horseshoe member 75 and the adjacentsegment of the first ring member 121 is opposite to the orientation ofthe diagonal connection 76 between the horseshoe member 75 and theadjacent segment of the second ring member 122. Compare 170 a and 170 bin FIG. 3A. Preferably, the orientation of the horseshoe member 75 anddiagonal member 76 connecting masts to the first ring member 121 havethe same orientation, and horseshoe member 75 and diagonal member 76connecting masts to the second ring member 122 have the sameorientation. The horseshoe member 75 at the pivot point 170 spreadsdisplacements so that the strains are lower, and the diagonal connection76 reduces angular displacements thus reducing strains. Optionally, thehorseshoe-diagonal connection pivot point 170 may be the same width asthe masts.

Alternatively, pivot points, whether S-shaped or horseshoe-diagonal orsome other geometric shape, also, or instead, may have less thickness(e.g., smaller gauge)—in other words the portion that bends may bethinner than the mast or ring member structures in addition to or as analternative to the favorable geometric pivot point shape. Connectionsbetween mast and ring members may alternatively include hinges.

When the valve frame 120 of the embodiment of FIGS. 3A-B is in itsworking configuration, the horseshoe/diagonal pivot points 170 areplanar. The planar construction of the embodiment of valve frame 120 isillustrated in FIG. 4A, which shows that viewed from the top, the valveframe appears as two round rings, which are the first ring member 121and the second ring member 122. FIG. 4B depicts the embodiment of valveframe 120 with the horseshoe/diagonal pivot points 170 in its workingconfiguration, viewed from the side. This perspective shows that thefirst and second ring members 121, 122 in this embodiment are not simplerings, but appear “wavy”. Compare the first and second ring members ofFIG. 4B to those in the embodiment illustrated in FIG. 2. Ring shafts 37on the masts are also shown. Nevertheless, the ring members 121, 122 ofthe embodiment of FIGS. 3A-4B are substantially collinear to each otherand the masts in the folded delivery configuration.

To percutaneously deliver the valve module, the masts 25, 28 a, 28 b maybe folded so that the the substantially linear ring members 21, 22, 121,122 and masts are oriented in the same general direction, to form asubstantially collinear valve frame, and—with the valve leaflet(s)15—may be wrapped in a spiral around a guide wire 86, as shown in FIG.5. This method of folding the valve module permits the guide wire 86 topass through the center of the spiraled linear valve frame and valveleaflets. A guide wire lumen may extend through the catheter 85 and thevalve module 10 may be folded around the guide wire lumen or around theguide wire and, as shown in FIG. 6A, loaded in a catheter 85 (depictedas a clear tube for purposes of illustration) for delivery of the valvemodule. When the valve module 10 is deployed, the valve framefacilitates unfolding of the valve module (FIG. 6B) and the formation ofa generally rounded shape (see FIGS. 7C, 7D). The capability of themasts to be folded down on the ring members to form the substantiallycollinear valve frame helps provide a minimized delivery diameter forthe valve frame, and thus the valve module.

The support module may comprise a plurality of cells defined byfilaments or struts, as shown in FIGS. 14B, 14D (see also FIGS. 7A-B,8A, 10A). The plurality of cells may include one or more large cells 43,as shown in FIG. 14B (see also FIGS. 10A-B, 14C-D), to accommodatepotential vascular intervention procedures that may be necessary inpatients who have had the modular valve previously implanted. The largercells 43 provide access through the implanted valve, for example, forcatheters to be steered into coronary arteries.

When deployed, the support module should engage the valve annulus (orfor example in an aortic valve replacement, the orifice of the leftventricle), pinning back the native valve leaflets, if not removed, soas to be secure therein so that the valve module does not shift in thelumen and is not displaced from the desired location, for example fromthe pressure of fluid flow through the valve or its impact on the closedvalve. The support module may also enlarge the orifice of a stenoticvalve. In one embodiment, the shape of the support module is annularwith a uniform diameter, but it may be provided in other shapes too,depending on the cross-sectional shape of the lumen at the location thevalve is to be implanted. Thus, for example, in its expandedconfiguration, the support module may have a non-uniform diameter alongits longitudinal axis. The diameter of the proximal and distal ends ofthe support module may be the same or different. In one embodiment,illustrated in FIG. 14B, the support module may have a smaller diameterin the center region than at the proximal and distal ends. In such anembodiment, a longitudinal cross-section through the midline of thesupport module would have an hour glass or dog-bone shape. Such a shapemay facilitate seating the support module in the valve annulus and/orimprove sealing of the valve against the native anatomy.

As illustrated in FIGS. 7A-E, the system of the invention includes adelivery system 87, including a delivery device such as a catheter 85,for delivering the device modules in their low profile deliveryconfigurations and from which the device modules may be deployed. Thesystem also includes assembly wires 80 and pusher members 81, used fordeploying and assembling the modular valve device of the invention.

The valve device of the invention may include a plurality of sets oflocking members designed to lock the valve module to the expandedsupport module. Any of a variety of locking members may be used to lockthe valve module to the support module, or for locking the ends of theunassembled valve module to one another. Examples of such lockingmembers are described in detail in ¶¶83-111, 113 and FIGS. 7, 7A, 8A-14Cof US 2010/0185275A1, incorporated herein by reference. Novel lockingmembers, as described in more detail below, are preferred. Each set oflocking members may comprise a first locking member and a second lockingmember. The first locking member of the locking member set may beattached to one of the masts of the valve frame and a second lockingmember of the locking member set may be attached to the support module.The first and second members of each set are circumferentially alignedwith each other, and in a preferred embodiment, a wire guide iscircumferentially aligned with a first locking member.

The first and second locking members may comprise a spear and acorresponding shaft having a lumen, wherein the spear has a first spearend and a second spear end, and a spearhead at the first spear end, thespearhead including an eyelet and an elongated aperture. Thus, in oneembodiment employing novel locking members of the invention, the supportmodule 40 has a plurality of spears 45, 145 at its distal end 42, whichspears are designed to align with the plurality of shafts 35, 135, 136.In FIGS. 8A-B, 9A-B, 10A-B, shafts 35, 135, 136 or ring shafts 37 arelocated on the masts 25, 28 a, 28 b of the valve frame. In otherembodiments, the shafts 35, 135, 136 or ring shafts 37 may be located onthe one or more ring members 21, 22 of the valve frame, or the shafts35, 135, 136 or ring shafts 37 may be located on a combination of mastsand ring members. The spear and shaft embodiment of locking mechanismmay be described generally with reference to the non-limitingembodiments of FIGS. 8A-B, 9A-B. Each spear 45 may have an eyelet 46through which an assembly wire 80 may be threaded. See FIGS. 8B, 9B.Alternatively, the assembly wire 80 may be threaded through a portion ofthe support module (not shown).

In another embodiment, the spears 45 may be located on the valve frame,with the spearhead at the proximal end of the valve module, and theshafts 35, 135, 136 and/or ring shafts 37 may be located on the supportmodule 40. In such embodiments, the valve module may be pushed into thesupport module along the assembly wires using push members, or pulledinto the support module, as described in more detail below.

The spears 45 may include spearheads 47 having geometricalconfigurations that prevent the valve module from moving distally out ofthe support module, thereby locking the valve module to the supportmodule. As illustrated in FIGS. 8A-B, the spearhead 47 comprises aflexible section, designed in this embodiment as a “kite”. The spearhead47 is shaped so as to flex to allow a shaft 35 to be eased over thespearhead 47 of the spear 45 using a pusher member 81 (see above, FIGS.7D, 7E), but to prevent the shaft 35 from slipping back distally,thereby locking the valve module to the support module. Other geometricconfigurations also may be used, for example without limitation,diamond, circular, arrowhead, rivet, hook, ball/bulb and comparableshapes that permit unidirectional movement.

The assembly wire 80 is shown in FIGS. 8A and 8B looped through theeyelet 46 of the spear 45, and the shaft 35 is shown locked between thekite spearhead 47 at the distal end of the spear 45 and a spear cross 49proximally. Alternatively, the assembly wire may be looped through aneyelet of one spear, around a portion of the support module and throughthe eyelet of an adjacent spear, or two adjacent spears, back up througha different wire guide, for example associated with a shaftcorresponding to an adjacent spear. Such an arrangement decreases thenumber of required assembly wires for guiding the valve module to thesupport module. In a further alternative embodiment, the assembly wiremay be looped through a portion of the support module, as described inone aspect in US 2011/0172784A1, incorporated herein by reference.

Where the valve frame includes a split mast, the split mast may includea pair of shafts, a first shaft 135 on the first half of the split mast(obscured), and a second shaft 136 on the second half of the split mast28 b, as illustrated in FIG. 9A. In this way, as the first and secondshafts 135, 136 are eased over the spearhead 47, the first and secondshafts 135, 136 simultaneously close the valve module to form thecylindrical working configuration. As in FIG. 8B, the spear 45 withspearhead 47 shown in FIG. 9B includes a spear cross 49 as a backstop,so that the valve module does not move proximally in the support moduletoward the heart. However in FIG. 9B, it is the wire guide 30, not theshafts, that abut the spear cross 49 and “seat” the shafts on the spear45.

In another embodiment of the spear-shaft locking members, illustrated inFIGS. 10A-B, the spear is a hybrid spear 50, and a ring shaft 37 may beeased over a hybrid spear 50 to lock the valve module to the supportmodule. The details of one embodiment of the hybrid spear 50 are shownin FIGS. 11A-C, the main structural elements being separated segmentsand a groove. The hybrid spear 50 includes segments 51 a, 51 b separatedby an elongated aperture 54, which elongated aperture 54 permits thesegments 51 a, 51 b to flex slightly toward one another as the ringshaft 57 is slid over it, and a groove 53 into which the ring shaft 37may come to rest, thereby locking the ring shaft 37 on the hybrid spear50. In the embodiment depicted in FIGS. 11A-C, there are two segments,however a hybrid spear having more than two segments is within the scopeof the invention. FIG. 11A shows the eyelet 52, segments 51 a, 51 b, andgroove 53. FIG. 11B shows a ring shaft 37 being eased onto the hybridspear 50. FIG. 11C shows the ring shaft set in the groove 53 (obscuredby the ring shaft) of the hybrid spear 50, thereby locking the valvemodule to the support module.

In yet another embodiment of locking members, illustrated in FIGS. 12A-Band 13A-B, a one-sided hybrid spear 60 comprising a spearhead 61 andstem region 68 that cooperates with a plurality of ring shafts 66, 67and/or shafts 65 a, 65 b to lock the valve module to the support module.The spearhead 61 includes two segments separated by an elongatedaperture 64 and a single groove 63 on the outer edge of one of thesegments and an eyelet 62. The spear head 61 of the one-sided spear 60may have a smaller diameter than the stem 68 and/or be tapered from afirst end, where the eyelet 62 is located, toward the groove 63, butflares on one side to produce a wedge shape just above the groove 63visible in FIGS. 12B, 13B. The diameter or width of the spear head 61 atthe wedge does not exceed the diameter or width of the stem 68. Anassembly wire may be threaded through the eyelet 62 at the top of thespear head 61.

FIGS. 12A-B illustrate a one-sided spear 60 locked into ring shafts 66and 67 (single-groove snap lock), which are attached to a mast 25. FIG.12A shows a lower or first ring shaft 66 on the stem region 68 of spear60 and an upper or second ring shaft 67 in a groove 63 of the spear head61. The spear 60 includes at the base of the stem region 68, a spearstop 69, which limits the advance of the lower first ring shaft 66 overthe spear 60. FIG. 12B is a cut-away view, revealing the structure ofthe spear head 61, which includes two segments join at each end thatdefine an aperture 64. On the outer edge of one of the segments is agroove 63. FIG. 12B also illustrates the inner structure of the lowerand upper ring shafts 66, 67. The ring shafts 66, 67 have lumens withdiameters large enough for the spear 60 to fit on. The lumen diameter ofthe first ring shaft 66 is substantially the same as the width of thestem region 68. The the lumen diameter of the second ring shaft 67 issmaller than the width of the stem region 68, and substantially the sameas the width or diameter of the spearhead 61 at the point of the groove63, allowing it to lock into the single groove 63 of the spear 60.

A one-sided spear 60 is particularly useful in conjunction with shaftson split masts 128 a, 128 b, as illustrated in FIGS. 13A-B. The spear 60of FIGS. 13A-B is the same as spear 60 in FIGS. 12A-B, but the shaftsdiffer to accommodate the split masts 128 a, 128 b. As depicted in FIG.13A split mast 128 a may have a shaft 65 a and a ring shaft 67 attachedto it, and split mast 128 b may have a shaft 65 b attached to it, all ofwhich shafts 65 a, 65 b and ring shaft 67 may be slid over the spear 60to lock the sides of the valve module together and lock the valve moduleto the support module. FIG. 13B is a cut-away view, revealing thestructure of the spear head 61, as in FIG. 12B—the two segments thatdefine an aperture 64 and groove 63 on the outer edge of one of thesegments. FIG. 13B also illustrates the inner structure of the shafts 65a, 65 b and ring shaft 67. The lumen diameters of the shafts 65 a, 65 bare substantially the same as the width or diameter of the stem region68 of spear 60. The lumen diameter of ring shaft 67 is smaller than thewidth or diameter of the stem region 68, and substantially the same asthe width or diameter of the spearhead 61 at the point of the groove 63,allowing it to lock into the single groove 63 of the spear 60. In oneaspect of this embodiment ring shaft 67 and shaft 65 b may be located onone half of the split mast 128 b and shaft 65 a may be located on theother half of the split mast 128 a. In an alternative aspect, what isdepicted in FIGS. 13A-B as ring shaft 67 may be a region of shaft 65 awith smaller inner diameter, located on one half of the split mast 128 aand shaft 65 b may be located on the other half of the split mast 128 b.Other combinations of shafts and ring shafts may be used with the splitmasts 128 a, 128 b, but all ring shafts/shafts have a diameter largeenough to slide over the stem region 68 of spear 60, except for the onethat fits into the single groove 63.

In either embodiment, where the single groove, one-sided spear 60 isused with a mast 25 or split masts 128 a, 128 b, the maximumwidth/diameter of the spear head 61 flare or wedge is not greater thanthe width/diameter of the stem region 68 and the elongated aperture 68functions to allow at least one segment of the spear head 61 to flextoward the other upon application of stress. Thus, the shafts or ringshafts 65 a, 65 b, 66 with the larger lumen diameter may readily slideover the spear head 61 without flexing the segments of the spear headtoward the elongated aperture 63. The ring shaft 67 (or ring shaftportion of a shaft), by contrast, having a narrower lumen diametercauses at least the segment of the spearhead 61 having the flare orwedge to flex, and subsequently the ring shaft 67 comes to rest in thegroove 63. More particularly, the first ring shaft 66, the lower shafthaving the larger luminal diameter, is eased over the spear 60 first,but pushing on a pusher 81. The segments on either side of the elongatedaperture 64 does not flex as the first ring shaft 66 is slid over it, inview of the luminal diameter of the first ring shaft 66. The second ringshaft 67, the upper ring shaft having the smaller lumenal diameter, isthen pushed over the spear head using the pusher 81. The elongatedaperture 64 of the spearhead permits flexing of a segment on at leastone side of the aperture 64 where the wedge is located, so that thesecond ring shaft 67 can be pushed over the largest flare of the taper,the wedge. The luminal diameter of the second ring shaft 67 designed tobe closely matched to the width of the groove 63, and second ring shaft67 the snaps into the single groove 63 of the one-sided hybrid spear 60.

An advantage of the one-sided spear 60 in combination with ring shaft 67and shafts 65 a, 65 b, 66 over, for example a hybrid spear asillustrated in FIGS. 10A-B and 11A-C, is it permits a narrower outerdiameter for both spear and shaft, which in turn reduces the overallprofile of the valve module. Another advantage is that less force isrequired to push the spear through the shafts.

As locking members, the shafts and ring shafts are designed to interactwith the spears to seat the valve module in the support module and lockthe two device modules together, and/or to close the first and secondends of the valve module. Various combinations of spears, shafts andring shafts may be used. Other locking members may be used in thealternative or in combination with the spears and shafts describedherein, and the pushers similarly may be used to engage the lockingmembers in addition to advancing the valve member over the assemblywires.

In certain embodiments, the wire guides may have an additional function.Where the pushers are used to advance the valve module into the supportmodule and to engage locking members, the wire guide 31 on the secondring may provide a surface upon which the pushers exert force. Using thewire guides for this purpose may provide the following, non-limiting,advantages of avoiding damaging the leaflet tissue and/or preventing thepushers from slipping off a ring surface. Similarly, where shafts arelocated on valve modules, the distal end of the shafts may be used as asurface against which the pusher members push the valve member. In someembodiments, a wire guide also may serve as a “seat” against the spearcross once the shafts are fully engaged on the spear (see e.g., FIG.9B).

Referring back to FIGS. 7A-E, which depict the system of the invention,a method of deploying and assembling the modular valve device of theinvention is illustrated. In this embodiment, an assembly wire 80 isthreaded through the wire guide 31 and looped through the eyelet of thespear and doubled back, so that the assembly wire 80 is a double wirethrough the wire guides prior to loading the device modules into thedelivery system. See FIGS. 8A-B, 9A-B, and 10B. In this way, after thesupport module 40 has been deployed, expanded and anchored at thelocation of valve implantation, the valve module 10 may be deployed fromthe delivery device, unfolded and made to ride down the assembly wires80 toward and into the support module 40. See FIGS. 7A-E. In anotherembodiment, the assembly wire may be threaded through the eyelet of onespear, around the support module through an eyelet of another spear andback up through another wire guide. Such an arrangement decreases thenumber of assembly wires required and preserves the ability to pull onone end of the assembly wire for removal.

Pusher members 81 may be slid over the assembly wires 80 and used topush the valve module 10 along the assembly wires 80. Pusher members 81may be, for example, hollow tubes through which the assembly wires 80are threaded, and which may be manipulated via the delivery system 87.Pusher members 81 may be used to deploy the valve module from thecatheter and/or to assist in assembling the valve module 10 and lock itto the support module 40. In any of these uses, the assembly wires 80are held at tension, so that the valve module 10 may glide over theassembly wires as though on rails. Wire guides 31 may be used not onlyto orient the valve module 10 relative to the support module 40, butalso in conjunction with the pusher members 81 to connect/attach thevalve module 10 and support module 40.

In another embodiment (not shown), each spear and its eyelet may belocated on the valve module, with the spearhead at the proximal end ofthe spear, and the shaft may be located on the support module. In thisembodiment, the catheter may be advanced through the support module pastthe proximal end 41 (see FIG. 10A) of the support module and used topull on the assembly wires thereby pulling the valve module into thesupport module and the spears into the shafts. In still anotherembodiment, the spears may be located on the valve module and the shaftson the support module, and the method may include advancing the catheterbeyond the proximal end 41 of the support module 40 and using theassembly wires 80 (and optionally pusher members 65) to pull the valvemodule 10 toward and into the support module 40.

Once the valve module and support module are assembled and lockedtogether, because each assembly wire 80 is a double wire, one end of theassembly wire 80 may be pulled to disengage the assembly wire from theimplanted, assembled valve device.

A method of deploying and assembling the modular device using the systemof the invention may proceed as follows: advancing the delivery deviceso that its distal end is near a selected location, for example thelocation of valve implantation; deploying the support module from thedelivery device; expanding the support module at the selected location(where the support module is not self-expanding); deploying the valvemodule from the delivery device; advancing the valve module along theassembly wires toward the support module using the pusher members; andmoving each of the plurality of shafts over the corresponding spear tolock the valve module to the support module. The moving step may alsoinclude moving the first and second shafts of the split mast over thespear (or moving the spears into the shafts if the location of thespears and shafts on the device modules is reversed) to form a workingconfiguration valve module. In another embodiment, the valve module maybe deployed before the support module, and advanced into the supportmodule after the support module is seated in the native valve annulus.In this alternative method, the catheter containing the support modulemay be advanced through the deployed valve module and deployed, eitherthe catheter advanced further, and then the valve module may be pulledonto the support module, or the catheter may be withdrawn and pushersused to glide the valve module over the assembly wires onto the supportmodule.

As illustrated in FIG. 7A, the support module 40 has been deployed andexpanded at a selected location in a vessel 90 (the blood vesseldepicted as a clear tube for purposes of illustration) and the catheter85 withdrawn to provide space for deploying the valve module 10. Theassembly wires 80 are held taut, for example at a tension. FIG. 7Billustrates the folded valve module being deployed from the catheter 85,the first ring member 21 visible with the valve leaflet attached. InFIG. 7C, the valve module has been deployed and is unfolded, but not yetin a working configuration. The first ring member 21, second ring member22, a mast 25, first and second halves of a split mast 28 a, 28 b, andthe valve leaflet 15 are visible. The assembly wires 80 are shown tautbetween the support module 40, threaded through the wire guides (notshown) of the valve module and into the catheter 85. FIG. 7D illustratesthe pusher members 81 being deployed from the delivery system 87, theassembly wires 80 still held at tension. FIGS. 7D and 7E show how thepusher members 81 may be used to push the valve module 10 into thesupport module 40.

In certain embodiments, the deployed and unfolded valve module may bepulled into the support module via the assembly wires by a method thatfurther includes advancing the delivery device, for example a catheter,distally through the deployed valve module and the deployed and expandedsupport module to a point distal of the support module (i.e., beyond theproximal end of the support module) and pulling the assembly wires. Theshafts may be pulled over the spear heads of the spears to engage theshafts and spears by further pulling the assembly wires. Alternatively,the pushers may be used to pull the valve module into the support moduleand the shafts over the spearheads. In this aspect of the method, thepushers are extended beyond the distal end of the catheter, i.e., wellbeyond the proximal end of the support module. Advancing the pushers inthis manner effectively pulls on the taut assembly wires, therebypulling the valve module into the support module and effecting lockingof the locking members, such as pulling the shafts over the spearheads.In such embodiments, the spears may be located on the valve frame, withthe spearhead at the proximal end of the valve module, and the shaftsand/or ring shafts located on the support module.

FIGS. 14A-D are provided to illustrate the structures of the valvemodule and support module of the invention. FIG. 14A is a schematicdrawing based on a photograph illustrating an embodiment of a valveframe 20 for a valve module in accordance with the invention. Thedetails of valve frame 20 are depicted without the valve leafletsattached. In this embodiment the valve frame 20 has a first ring member21, a second ring member 22, a plurality of masts 25, including a splitmast, comprising split mast halves 28 a, 28 b, and pivot points 70. Inthis embodiment, the first ring member 21 is wider (longitudinally) thanthe second ring member 22, but has the same radial thickness. Also shownis one of a plurality of first wire guides 30 on the first ring member21 and one of a plurality of second wire guides 31 on the second ringmember 22, the second wire guides 31 having a surface (as depicted, aflat surface) for pushing members to push against. Exemplary lockingmembers are also depicted. Specifically, first and second ring shafts 37a, 37 b are located on each mast 25, first shaft member 135 on the firstsplit mast half 28 a and a second shaft member 136 located on the secondsplit mast 28 b half.

FIGS. 14B and 14C are schematic drawings based on photographs depictingembodiments of a support module 40 in accordance with the invention.These particular embodiments include spears 45 and one or more largecells 43, as discussed above. The large cells 43 are preferablypositioned at the distal end of the support module in embodimentsintended to be implanted to replace an aortic valve, where they may sitadjacent coronary arteries and provide access thereto. In otherembodiments, the position of large cells 43 and their size can beadjusted to accommodate the position and size of vessels to whichcatheter access may be desirable after implantation of the valve device.The support module 40 embodiment depicted in FIG. 14B has a middlesection with a narrower diameter than the proximal and distal sections,e.g., “hour-glass” shaped, as discussed above. The support module 40embodiment depicted in FIG. 14C has a wider diameter at its distal endthan at its proximal end, e.g., “pear” shaped. FIG. 14C furtherillustrates a valve frame 20, having a first and second ring member 21,22, locked to the support module 40 using an embodiment of hybrid spears150 and shafts and ring shafts. The connections are more readily viewedwithout valve leaflets attached to the valve frame. Assembly wires 80 a,80 b are also shown, in particular assembly wire 80 a is shown loopedthrough an eyelet of a hybrid spear and a wire guide 31 on the secondring 22. FIG. 14D is a schematic drawing based on a photographillustrating details of an embodiment of a hybrid spear 150 on a supportmodule, including the eyelet 152. A large cell 43 of the support moduleis also shown. The embodiment of a hybrid spear 150 in FIGS. 14B-D isdifferent from the hybrid spear 50 depicted in FIGS. 11A-C, butfunctions similarly with ring spears.

It will be appreciated by persons having ordinary skill in the art thatmany variations, additions, modifications, and other applications may bemade to what has been particularly shown and described herein by way ofembodiments, without departing from the spirit or scope of theinvention. Therefore it is intended that scope of the invention, asdefined by the claims below, includes all foreseeable variations,additions, modifications or applications.

What is claimed is:
 1. A valve module for a percutaneous modular valvedevice, comprising: a valve frame; and a plurality of valve leaflets,said plurality of valve leaflets attached to said valve frame; whereinsaid valve frame comprises a first ring member, a second ring member anda plurality of masts connected to and disposed between said first andsecond ring members, wherein one of said plurality of masts is alongitudinally split mast having a first mast half and a second masthalf; wherein said valve frame has a folded unassembled deliveryconfiguration and is assembled into a working configuration afterdeployment from a delivery device; wherein said first and second ringmembers are substantially collinear with said masts in said foldedunassembled delivery configuration.
 2. The valve module of claim 1,wherein said valve leaflets are attached to said first ring member andsuspended from said second ring member.
 3. The valve module of claim 1,wherein said valve leaflets are attached to said first ring member andsuspended from said plurality of masts.
 4. The valve module of claim 1,wherein said valve leaflets comprise a first material and are attachedto said valve frame via a sandwich attachment with a second material. 5.The valve module of claim 4, wherein said second material is Dacron. 6.The valve module of claim 1, wherein said first ring member is widerthan said second ring member along a longitudinal axis of said workingconfiguration valve module.
 7. The valve module of claim 1, wherein saidconnections between said plurality of masts and said first and secondring members are pivot points.
 8. The valve module of claim 7, whereinsaid pivot points are S-shaped.
 9. The valve module of claim 7, whereinsaid pivot points comprise a horseshoe connection and diagonalconnection.
 10. The valve module of claim 1, wherein said foldedunassembled delivery configuration comprises said valve leaflets andsaid substantially collinear first and second ring members and pluralityof masts are spirally wound around a guide wire.
 11. The valve module ofclaim 1, wherein said valve frame further comprises a plurality of wireguides.
 12. A modular percutaneous valve device comprising the valvemodule of any one of claims 1-11, further comprising: a support module,said support module having a compressed delivery configuration and anexpanded working configuration; and a plurality of complementary lockingmembers, for locking said valve module and said support module in saidexpanded working configuration.
 13. The modular valve device of claim12, wherein each of said complementary locking members comprises a spearand a shaft, said spear having a first end and a second end, said shaftfitting over said spear.
 14. The modular valve device of claim 13,wherein at least one of said spears includes a spearhead at said firstend and a spear cross at said second end.
 15. The modular valve deviceof claim 13, wherein at least one complementary shaft and spearcomprises a ring shaft and a hybrid spear.
 16. The modular valve deviceof claim 13, wherein at least one complementary shaft and spearcomprises a first ring shaft having a first internal diameter, a secondring shaft having a second internal diameter, and a one-sided hybridspear.
 17. The modular valve device of claim 13, wherein at least onecomplementary shaft and spear comprises a ring shaft having a firstinternal diameter, a shaft having a second internal diameter, and aone-sided hybrid spear.
 18. The modular valve device of claim 13,wherein said shafts are located on said masts of said valve frame andsaid spears are located on said support module, each spear aligned withone of said plurality of masts.
 19. The modular valve device of claim13, wherein said first mast half of said valve frame includes a firstshaft, said second mast half includes a second shaft, said first shaftlocated proximal of said second shaft along a longitudinal axis of saidvalve module, said first and second shafts designed to lock to a singlecorresponding spear on said support module.
 20. A system for deployingthe percutaneous modular valve device of any one of claims 12-19,comprising: a delivery device; a plurality of assembly wires; and aplurality of pusher members; wherein each assembly wire is threadedthrough one of said pusher members, and said valve module and supportmodule in said delivery configurations.
 21. The system of claim 20,wherein said valve frame includes said plurality of wire guides, saidwire guides comprising a plurality of first wire guides attached to saidfirst ring member and a plurality of second wire guides attached to saidsecond ring member, said assembly wire threaded through said first andsecond wire guides.
 22. The system of claim 20, wherein saidcomplementary locking members are selected from the group consisting of:(a) shaft and spear, (b) ring shaft and hybrid spear, (c) first ringshaft having a first diameter, second ring shaft having a seconddiameter and single groove hybrid spear, and (d) combinations thereof;wherein said shafts, ring shafts, and first and second ring shafts arelocated on said masts of said valve frame and said spears are located onsaid support module, each spear, hybrid spear and single groove-hybridspear having an eyelet at said first end, said assembly wire threadedthrough said eyelet.
 23. A method of assembling a modular percutaneousvalve device using the system of any one of claims 20-22, the methodincluding: deploying said support module from said delivery device;deploying said folded unassembled valve module from said deliverydevice; sliding said valve module along said assembly wires into saidsupport module using said pusher members; and locking said valve modulewithin said support module to form a working configuration valve module.24. The method of claim 23, further comprising: guiding each of saidplurality of shafts over said complementary spears using said pushermembers to lock said valve module to said support module.
 25. The methodof claim 24, wherein one of said plurality of masts is a split masthaving a first mast half and a second mast half, said first mast halfhaving a first shaft, said second mast half having a second shaft, saidfirst shaft located proximal of said second shaft along a longitudinalaxis of said valve module, said first and second shafts designed toconnect to a single complementary spear; wherein said guiding stepincludes guiding said first and second shafts of said split mast oversaid corresponding spear to close said first and second ring members tolock closed said working configuration valve module.
 26. A modularpercutaneous valve device comprising: a valve module, said valve moduleincluding a valve frame and a plurality of valve leaflets attachedthereto, said valve frame including at least one ring member and aplurality of masts connected thereto, wherein said valve module has afolded unassembled delivery configuration and an assembled workingconfiguration, each ring member having a substantially straight deliveryconfiguration with a first end and a second end; wherein in said foldedunassembled delivery configuration each ring member extends in the samegeneral direction as said plurality of masts, said plurality of mastssubstantially orthogonal to said ring member in said assembled workingconfiguration; a support module, said support module having a compresseddelivery configuration and an expanded working configuration; aplurality of sets of locking members designed to lock said valve moduleto said expanded support module, each set of locking members comprisinga spear and a corresponding shaft having a lumen, wherein said spear hasa first spear end and a second spear end, and a spearhead at said firstspear end, said spearhead including an eyelet and an elongated aperture;and a plurality of wire guides located on said ring member.
 27. Thevalve device of claim 26, wherein said at least one ring membercomprises a first ring member and a second ring member, said pluralityof masts disposed therebetween, and said valve leaflets are attached tosaid first ring member and suspended from said second ring member. 28.The valve device of claim 26, wherein said valve leaflets are attachedto a first ring member and suspended from said plurality of masts. 29.The valve device of claim 26, wherein one of said plurality of mastsincludes a split mast having a first mast half connected to said firstend of said ring member and a second mast half connected to said secondend of said ring member.
 30. The valve device of claim 26, wherein saidspearhead has a shape selected from the group consisting of: adiamond-shape, a rhombus, a trapezoid, a kite, a circle, a rectangle, anoval, an arrowhead, a sphere, an ovoid, and a bulb.
 31. The valve deviceof claim 26, wherein said spear further comprises a spear-cross at saidsecond spear end, said corresponding shaft designed to lock between saidspearhead and said spear-cross.
 32. The valve device of claim 26,wherein said spear is a hybrid spear, wherein said spearhead furtherincludes a groove; and wherein said shaft comprises a ring shaft havinglumenal diameter comparable to a width of said spearhead at said groove.33. The valve device of claim 32, wherein said groove is located on onlyone side of said hybrid spear, said hybrid spear further comprising astem; and wherein said ring shaft comprises a first ring shaft having afirst lumenal diameter comparable to a width of said spear at said stemand a second ring shaft having a second lumenal diameter comparable tosaid spearhead width at said groove.
 34. The valve device of claim 32,wherein said groove is located on only one side of said hybrid spear,said hybrid spear further comprising a stem; and wherein said shaftfurther comprises a first shaft and a second shaft, said first andsecond shaft having a first lumenal diameter comparable to a width ofsaid spear at said stem, said ring shaft having a second lumenaldiameter comparable to said spearhead width at said groove.
 35. Thevalve device of claim 26, wherein one of said plurality of masts is asplit mast having a first half connected to said first end of said ringmember and a second half connected to said second end of said ringmember, and wherein said first split mast half includes a first shaft,said second split mast half includes a second shaft, said first shaftlocated proximal of said second shaft along a longitudinal axis of saidvalve frame, said first and second shafts designed to lock to a singlecorresponding spear.
 36. A system for deploying a percutaneous modularvalve device, comprising: the modular valve device of any one of claims26-34, and 35; a delivery device; a plurality of pusher members; and aplurality of assembly wires; each assembly wire threaded through atleast one of said plurality of pusher members, at least one of said wireguides and at least one of said eyelets, to guide said valve module tosaid support module by advancing said pusher member, at least one ofsaid wire guides having a surface for said pusher member to exert forceand engage said sets of first and second locking members.
 37. A methodof assembling a modular percutaneous valve device using the system ofclaim 36, the method including: deploying said support module from saiddelivery device; deploying said folded unassembled valve module fromsaid delivery device; guiding said valve module along said assemblywires into said support module using said pusher member; and engagingsaid first and second locking member sets using said pushing member toclose said valve module to form a working configuration valve module andlock said valve module within said support module.
 38. The method ofclaim 37, wherein one of said plurality of masts is a split mast havinga first half and a second half, said first split mast half having afirst shaft, said second split mast half having a second shaft, saidfirst shaft located proximal of said second shaft along a longitudinalaxis of said valve module in the assembled working configuration, saidfirst and second shafts designed to lock to a single correspondingspear; wherein said guiding step includes guiding said first and secondshafts of said split masts over said corresponding spear to close saidat least one ring member.